Integrated OutcomesTM

Unprecedented Capture of Outcomesfor Outpatient Interventions with Easy Work-flow Integration

Duane Steward, DVM, MSIE, PhDStewardd@saic.com duane@medg.csail.mit.edu321 939-7912 cell: 407 230-6081

What is it?

> Method for Managing Results> Based on a Simple

Fundamental Technology> Product and a Service

Agenda

>What>Why>How

Architecture of Integrated OutcomesTM

> Medical record entry as trigger (e.g., ICD10 code)

> Knowledge-based System for construction of inquiry

> Timely inquiry> Patient responses in medical record> Knowledge-based System for provider response

recommendation> Role specific prompting for provider staff

Integrated OutcomesTM Diagrammed

Integrated OutcomesTM Diagrammed

Integrated OutcomesTM Diagrammed

Integrated OutcomesTM Diagrammed

Why Integrated OutcomesTM?

> C Everett CoopOutcomes Measurement

> Influence medical decisions> Inform present with the past> Inform the future> Quality of Care

Changed with timely feedback

> Reduce Uncertainty

Outcomes Capturing Precedent

> InpatientHospitalOfficeLaboratoryRehabilitation

> OutpatientObituariesScant instances of ad hoc local efforts

Why Are Not More Outcomes Measured?

> Cost of asking> Tedium

Consuming Time & Resources> Patient compliance

Most too intimidated to bother the provider unless severe> Manageability of response> Patient knowledge is not

InformedStructuredSystematized . . . therefore not reliable

What Can We Expect With Integrated OutcomesTM

> Outpatients asked about outcomes> Well timed> Structured

Intervention specificConsistent solicitation

> SystematicImpact on Statistics and Sample SizePotential for Machine Learning & Analysis

> Not Burdensome, Cost-effective> Better follow-up

Impact on Quality of Care

> Unprecedented Information

> More Consistency in Delivery and Follow-up

> Earlier Notice

> Highly Organized

> Minimized Cost

Integrated OutcomesTM Technology

> Reasoning Engine

> Knowledge-base

> Infrastructure InterfacesE-mail (or Postcard)

Medical Records

Reasoning Engine

> Expert SystemJava Expert System Shell used for prototyping

Separate Knowledge-base from Inference Engine

Needs no modification or rebooting when Rules are added or modified in the Knowledge-base

Knowledge-base

> Consists of Healthcare Provider ProtocolsQuestions asked of patients

Timing of patient inquiry

Responses of staff to outcomesNature of response

Role to respond

> Tailored to Institution, Practice, Clinic, Provider or Specific Clinical Study

> Extensible Knowledge-base w/o Modification of Infrastructure

Sample Rules (from proof-of-concept)

(protocol(intervention "Recommendation to watch for redness, swelling or other systemic symptoms")(question "Which of the following have occurred?")(answers "Nothing; no evidence remains of the tick bite. I am still waiting to hear results of the blood work."

"Nothing; no evidence remains of the tick bite. I was informed that the results of the blood work

were negative.""Redness remains where the tick was removed.""The area of redness has grown larger than a dime where the tick was removed.""Swelling has occurred or remains where the tick was removed.""Redness and swelling both occurred or remain where the tick was removed.""Other skin lesions have arisen not located at the site where the tick was removed.""Any of the following symptoms have occurred: malaise, fever, fatigue, headache, or other

flu-like symptoms.""Other symptoms that I did not expect have occurred."))

Sample Rules (from proof-of-concept)

(protocol(intervention "doxycycline 100mg BID PO 10 days")(question "Please select one or more responses concerning your condition.")(answers "I have taken my medication twice daily every day for one week."

"I have taken my medication almost regularly for one week (missed < two

doses).""I have missed more than two doses but am still taking medication after

7 days."

"I have stopped taking my medication within seven days of starting.""The redness/swelling under my arm has improved or disappeared after

one week on doxycycline."

"The redness/swelling under my arm has worsened after one week on doxycycline."

"One or more of the following symptoms: malaise, fever, fatigue, headache,

etc., occurred while taking doxycycline for one week.""No change after one week of doxycycline.""Other - please explain."))

Sample Rules (from proof-of-concept)

(respProtocol(feedback "Nothing; no evidence remains of the tick bite. I am still waiting to hear results of the blood work.")(actions "Call now and reassure results are on the way"))

(respProtocol(feedback "Nothing; no evidence remains of the tick bite. I was informed that the results of the blood work were

negative.")(actions "Email congratulations"))

(respProtocol(feedback "Redness remains where the tick was removed.")(actions "Make follow-up appointment."))

(respProtocol(feedback "Other symptoms that I did not expect have occurred.")(actions "Call to ask about the unexpected symptoms."))

(respProtocol(feedback "The redness/swelling under my arm has improved or disappeared after one week on doxycycline.")(actions "Ask again in three days"))

(respProtocol(feedback "The redness/swelling under my arm has worsened after 10 days on doxycycline.")(actions "Make follow-up appointment and extend prescription of doxycycline."))

Infrastructure

> AutomatedConstruction of questions

Timing of inquiry

Recommendations for staff response

> Effortless Medical Record Updates> Compiled Lists of Tasks for Staff

Service

> Knowledge-baseRefinement

Extension

Maintenance

Analysis

> Collected DataAnalysis of Data

Machine Learning and Induction of New Rules

Re-integration into Knowledge-base

Beneficiaries> Pharmaceutical Companies

Clinical Trial Outcomes and Monitoring

> Health Maintenance OrganizationsEnsure Cost Effective Care and Responses

> CliniciansClose MonitoringFeedback on Practice

> EmployersOptimized Healthcare Benefit ExpensesMaximized Productivity

> PatientsBetter Care, Better ResponseConfidence in Personal Contributions & Provider Responsiveness

What is it?

>Method for Managing Results>Based on a Simple

Fundamental Technology>Product and a Service

Integrated OutcomesTM

Unprecedented Capture of Outcomesfor Outpatient Interventions with Easy Work-flow Integration

Duane Steward, DVM, MSIE, PhDStewardd@saic.com duane@medg.lcs.mit.edu321 939-7912 cell: 407 230-6081